Provider Demographics
NPI:1659625796
Name:DR. DAN CHAVIRA MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. DAN CHAVIRA MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CHAVIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-923-9931
Mailing Address - Street 1:3661 TORRANCE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4886
Mailing Address - Country:US
Mailing Address - Phone:310-923-9931
Mailing Address - Fax:
Practice Address - Street 1:3661 TORRANCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4886
Practice Address - Country:US
Practice Address - Phone:310-923-9931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89310261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty